DESCRIPTION (provided by investigator): Asthma is a leading cause of childhood morbidity, however the burden falls disproportionately on minority children and children of low socioeconomic status. Despite advances in asthma care, disparities in rates of asthma emergency room (ER) visits, hospitalizations, and re-hospitalizations remain persistently high. The NIH seeks personalized approaches based on genes and biomarkers to identify and treat diseases at their earliest stages. Similar tailored approaches must be developed to prevent and ameliorate racial disparities in health at their earliest stages. This applications seeks to characterize remediable social and environmental factors most relevant to excess asthma morbidity in disadvantaged children. The central objective of this project is to examine children hospitalized with asthma to explore how race shapes social and environmental factors and how these, in turn, may influence the likelihood of re- admission for asthma. Genes are not a focus of the current applications, but DNA will be collected for future gene-environment studies. Fully characterizing the social and environmental components of race differences will help ensure that the search for genetic susceptibilities is a thoughtful and balanced one. We will enroll a population-based prospective cohort of children hospitalized with asthma and examine their risk of re-hospitalization and ER use for asthma over time with a primary focus on disparities in readmission. The specific aims are to: 1) characterize racial differences in risk of asthma-related re- hospitalization and ER visits after an index hospitalization and to examine in detail the potential contributions of socioeconomic status to that disparity (contrasting individual and area level measures of SES), 2) examine selected environmental exposures (traffic exposure, biomarker of tobacco smoke exposure, allergic sensitization) and psychosocial variables (adherence, caregiver stress) in relation to both asthma morbidity and race, and 3) examine the extent to which these environmental and psychosocial exposures explain disparities in time to asthma re-hospitalization rate and ER visits. This study offers a careful characterization of disparities in asthma morbidity along with a detailed look at potential mediators of these disparities. The innovation of the grant includes its focus on pathways most relevant to disease disparities, its broad 'geography to genes' framework, its emphasis on children at highest risk, and its population-based sample. This submission by a new investigator brings together stellar investigators with a broad spectrum of expertise. Moreover, the research occurs in an institutional environment with highly developed asthma research programs and one committed to developing effective interventions. We envision moving aggressively toward real-time clinical interventions that tailor effective disease management plans best suited to help children with the fewest resources.